Objective: Age is the strongest contributor to 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. Some older adults have a predicted ASCVD risk >= 7.5 %, without established risk factors. We sought to compare ASCVD incidence among adults with predicted ASCVD risk >= 7.5 %, with and without established ASCVD risk factors, to adults with predicted risk <7.5 %.Methods: We analyzed data from REasons for Geographic and Racial Differences in Stroke study participants, 45-79 years old, without ASCVD or diabetes, not taking statins and with low-density lipoprotein cholesterol 70-189 mg/dL. Participants were categorized into 3 groups based on their 10-year predicted ASCVD risk and presence of established risk factors: <7.5 %, >= 7.5 % with established risk factors and >= 7.5 % without established risk factors. Established risk factors included smoking, systolic blood pressure >= 130 mmHg or antihypertensive medication use, total cholesterol >= 200 mg/dL, or high-density lipoprotein cholesterol <50 mg/dL for women (<40 mg/dL for men). Participants were followed for ASCVD events.Results: Among 11,115 participants, 911 incident ASCVD events occurred over a median of 11.1 years. ASCVD incidence rates were 3.6, 12.8, and 9.8 per 1,000 person-years for participants with predicted risk <7.5 %, predicted risk >= 7.5 % with established risk factors and predicted risk >= 7.5 % without established risk factors, respectively. Compared to adults with predicted risk <7.5 %, hazard ratios for incident ASCVD in participants with risk >= 7.5 % with and without established risk factors were 3.58 (95 %CI 3.03 - 4.21) and 2.72 (95 %CI 1.91-3.88), respectively.Conclusions: Adults with a 10-year predicted ASCVD risk >= 7.5 % but without established risk factors had a high ASCVD incidence.
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